Where social justice & birth activism meet

experiences from the clinic

There was a post on Jezebel last week that tackled the question of how to help a friend through an abortion. It was a follow-up to a similar post about helping a friend through a miscarriage. Both posts are worth checking out, as they give good advice to friends and support people.

The main takeaway from both, which happens to be my main tactic as an abortion doula, is listen and don’t assume.

Most of the time people looking for support really just want to be heard and to have their feelings validated. They don’t want to be told they should feel differently than they do, or even necessarily helped to cheer up. Think about it next time you are struggling–what do you really need?

Because pregnancy, and especially abortion, are such hot-button political issues, we’ve all got an opinion about it. We’ve all got the latest anti-abortion injustice on our minds.

People are often surprised when I tell them that my work as an abortion doula is mostly about listening, and hand-holding. Not a lot of talking, or educating, or even really doing. A lot of smiling, a lot of encouragement to breath and relax, and a whole lot of listening.

With friends and family members the temptation to give advice is really strong, because we know them and their life and might think that means we know what is best for them. But unless someone is asking us for advice, or asking questions, the best thing we can do is listen and validate how they are feeling. The reality is we don’t know what’s best for anyone other than ourselves.

This is something I’m working hard to apply to my everyday life, but it definitely applies in the context of abortion or miscarriage support.

The only correction I’ll provide to the Jezebel post is to this part:

Baumgardner notes that abortion doulas can offer support to women going through the procedure — you can help her figure out if a doula is right for her, or help her locate one.

While abortion doulas do obviously exist, I know of no programs where individual people can seek out and bring a doula along with them to a clinic. Most of the abortion doula programs partner with clinics directly, so if you went to one of those clinics, you’d most likely encounter a doula there who would accompany you.

What the article references is more like a birth doula situation. It’s possible that abortion doulas will shift to that model some day, but for now it’s primarily clinic partnerships. If there is an abortion doula group in your area (I have a list here, any programs with asterisks) you could get in touch with them to see what clinics they serve, and choose your provider that way.

Like this:

Two of the three women at the clinic last week who were having “abortions,” were actually having D&C’s (the medical name for the procedure used during most first trimester abortions) to deal with incomplete miscarriages.

Both were wanted pregnancies, and both had been experiencing vaginal bleeding for a number of weeks. Both basically had their pregnancies terminated via natural causes, aka a miscarriage. Miscarriages are very common, and physicians estimate that between 10-15% of pregnancies end in miscarriage during the first 8 weeks. Some women may never know they are pregnant, but simply have a late period that could actually be a miscarriage.

Some miscarriages complete on their own, requiring no medical intervention. But some miscarriages might not complete fully (aka the contents of the uterus may remain) and necessitate medical intervention. The medical procedure for a miscarriage is basically the same as for a first trimester abortion.

A good percentage of the women I’ve supported in my abortion doula work aren’t actually choosing to terminate pregnancies–they are having medical procedures to treat their already-in-process miscarriages. These women are often ignored by the abortion debates which assume anyone getting what we call an “abortion” procedure is actually choosing to terminate.

Often the women who are having miscarriages in some ways need more support than those choosing to terminate. Like one woman I worked with last week, the pregnancy was very much wanted, and she was very sad to have lost it. While a woman choosing to terminate might feel relief once the procedure is over, a woman with a miscarriage might instead feel the immense sadness that comes from the reality that she is no longer pregnant.

A question remains about what would happen to these women if abortion were outlawed, or made inaccessible. Even if there were miscarriage exceptions in the law, it’s very possible that due to the burden to “prove” a miscarriage, plus the risk involved in providing the procedure, these women would be unable to get the procedure they need.

We saw the beginnings of this impact in Nebraska, where a woman was forced to carry a pregnancy to term despite the fact that they knew the child would die upon being born. For women who don’t want to go through the waiting and delivery with an unviable pregnancy, this is tantamount to torture.

In the case of early miscarriages that don’t complete on their own, we’re talking putting the mother’s life at risk–particularly if the limitations on abortion mean that doctors aren’t even learning to do these procedures.

I’ve talked before about the impacts of anti-abortion legislation on women who want to parent, and every time I work with someone at the clinic who is having an “abortion” to resolve an incomplete miscarriage, I’m reminded of this fact.

Like this:

Every shift I work at the hospital leaves me with many reflections on the experience of supporting women through abortions, the things I learn about their lives in the short time we spend together, the twisted way politics interferes with what happens there.

Every woman responds differently to the experience, brings a different level of energy, nervousness, calm.

This afternoon I’m thinking about one of the two women I supported this morning. She reminded me a lot of one of the first women I worked with. Both were emotional during the procedure, and when we talked afterwards, they explained how isolated and alone they felt. Both were Spanish-speaking immigrant women, both lived in close vicinity to extended family. Both talked about their partners, how unsupported and alone they felt as women–how they weren’t treated well. Me siento tan solita (I feel so alone) she told me this morning.

Often in the Latino community, we get stereotyped for being very family centered. Big families where everyone lives really close by, is very involved in each others lives. Often this is juxtaposed with the more American or Anglo family style–fewer kids, more distance between everyone, less involvement. Obviously these are generalizations, stereotypes, but I have felt the impact of American family culture in my own family–as a kid I remember spending much more time with cousins and Uncles and Aunts, grandparents, all of us together in summers and Christmas’s. Now as we’ve grown, this first generation of truly American children, we’ve scattered across the country, hundreds of miles from one another.

Sometimes I wonder what it would be like to be closer to everyone, to feel the warmth and stress and love of my blood relatives. Sometimes I wonder if we wouldn’t be better off, staying close, being more involved.

But then I’m reminded that it’s not always so simple, that it’s not always so black and white. Then I meet women like those I’ve met at the clinic, and I remember that family doesn’t always equal companionship. That sometimes, family relationships can be damaging, unhealthy, harmful. Both of these women hinted at abuse, neglect, mistreatment from their own family. This is how you come to feel so alone amongst many people.

The more I do this work, the more I think that most of my value as a doula in these moments is simply being a kind stranger who listens. I never feel like I’m doing very much, usually just making conversation, reassuring, holding hands and caressing shoulders. I’m a smiling face at the bedside without any other tasks than to just be present.

Today one of the women looked up at me during the procedure and smiled: Que bueno que estas aqui (How good that you are here). I responded: Mi placer (My pleasure). And it really is my pleasure, my delight that such a simple act might have an impact. Might make someone feel less alone and more resilient.

Before we parted ways she said to me Este trabajo que tu haces es muy lindo (This work that you do is very lovely).

Like this:

I arrive at the hospital around 9am, head up to the right floor, showing my volunteer ID badge to the security guard as I head toward the elevators.

I round the corner and enter the floor, delicately labeled Women’s Choices where the procedures will take place. I walk into the makeshift office/empty procedure room where the Residents/Doctors who will be performing the procedures sit debriefing the morning’s cases. I’m greeted by the Doula Project coordinator/Counselor at the hospital, and she debriefs with me about the folks on tap for the morning. While everyone is in for a first trimester abortion, the stories are different. Some are elective procedures, some are wanted pregnancies with medical issues–ectopic, fetal demise, etc.

I walk into the waiting room where the women are already wearing hospital gowns and socks, sitting nervously, quietly, waiting their turn. They are asked to arrive really early–7am–with the hope that it means most will be there by 9. I offer blankets, sometimes speaking in English and Spanish, sometimes using hand motions to communicate with patients who speak another language.

Everyone has been fasting since the night before, adding to the discomfort, tinging the air with acridity from hungry breaths. I sit, introduce myself to the patients, make polite conversation. Everyone responds differently, some want to talk, some want to sit quietly. Mostly I listen, try to remain attuned to the signals they send about whether they want company or silence.

Like this:

So I’ve been volunteering at a clinic, helping a midwife with translation (and other odd tasks) with her mostly Latina immigrant client base.

I’m really loving it, working with pregnant women again, doing direct service with latinas. I’ve missed being in a healthcare provider setting, and I miss doing doula work too. I’m working on it.

The women who come to the clinic get to decide where to give birth and with what type of provider. Her options are:

1) Hospital birth at teaching hospital with residents

2) Birth Center birth with Certified Nurse Midwives (CNMs)

3) Birth in the teaching hospital, but with care from CNMs from the birth center

This third option is really cool and not one I’d heard of previously. Most of the time, CNMs that deliver in hospitals are staff of the hospital and have a practice based there.

So the majority of the women this midwife sees choose hospital births. Now that midwives are an option in the hospital, it’s presenting a new possibility. But many of these women (like all women) have LOTS of preconceived notions about midwives. One woman who is almost due illustrates this really well:

Maria (not her real name) is from Honduras. She’s a spanish speaking immigrant and is pregnant with her third child. When we presented the possibility of having a midwife attend her birth in the hospital, she told me (after a little prodding) that her partner was really against her having a midwife. She said that he was born to a midwife at home in Honduras, and that the midwife dropped him on his head during the birth, which caused him to have a permanent eye deformity. Maria didn’t think it was worth it to fight with him about it, even though she was open to having a midwife there instead.

Ok, a few things about this. First, obviously the power dynamics between mom and partner are intense. Second, immigrants bring with them to the US all sorts of preconceived notions about how people should give birth. Some of it is based on life experience, like this, some of it is based on hearsay, feelings about class and health care models, a ton of things.

It’s very possible that her partner was delivered by a midwife at home. It’s also very possible that he was dropped at birth. It’s not necessarily true though, that it caused his eye deformity. The point is, it doesn’t matter, because this is the story he believes. And it’s informing his choices now. That’s a lot for providers here to contend with.

My main take away from all of this is that the issue of educating people about their birth options is so complex. It’s not just about what we’ve seen on tv, what we’ve heard from our families. There are layers upon layers of knowledge and preconceived notions we have to unpack to change the choices people make about how to birth. For immigrants we have to deal with a whole other cultural context, role for midwives, medical system and structure. Understanding this is the just the beginning of culturally competent care.

Like this:

It’s a tradition among the midwifery/birth/doula community to share birth stories, usually not long after you have participated in a birth. Everyone has their own process for sharing these stories, and the doula group I used to be a part of would have monthly meetings where doulas were invited to share. This process can be really cathartic for people, allowing them to process the experience and their feelings about it. Moms are also encouraged to share their birth stories with friends, family and their practitioners.

So I hadn’t planned on sharing a birth story just yet, but due to the cosmic nature of the universe and serendipity, I received an email this morning (only one day after starting this blog) from the father from my first ever official birth as a doula. He sent me a picture of their now 2 year old son, and told me they are expecting a sixth. I received this email with mixed feelings, because after a difficult 24 hours of labor, which ended with the midwife bringing in the obstretrical team to deliver the baby using forceps, the midwife disclosed to me that she did not think Barbara wanted to be having the baby. She felt that her mixed feelings about the pregnancy were demonstrated in her failure to progress in the labor, and that many of these feelings stemmed from her relationship with her husband.

So now they are pregnant again? I wish I could know more about how she is feeling about it. I also wish I could post the picture of their son here, because he is adorable (I even have a picture with me and the parents right after the birth) but that would be inappropriate and would be violating their confidentiality.